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Therapeutic Dilemma: What To Do?

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ButterflyBean

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Hi everyone,

It's been a long time since I've posted, but I do read other entries every day and comment from time to time. Amongst the every day stressors of life, which are further complicated by my physical disability/mobility impairment, I am trying to navigate a therapeutic dilemma that I never imagined myself in. The quick background is that I've been in therapy since age 14, have the same therapist since 2007 when I entered college, went through several different psychiatrists, and am diagnosed with depression, anxiety, suicidal ideation, and PTSD since 2012. Currently, my biggest issues surround abandonment, attachment, and connecting with my inner child.

Let me set the stage by saying that I'm currently pursuing my masters in counseling, so I am quite familiar with ethical principles in the USA, types of therapy, and fundamental principles/theories. I receive EMDR monthly and have a solid therapeutic alliance with all of my providers, which happens to be where the problem lies. You see, my insurance plan involves Medicaid because of other services I receive for my disability. Long story short, there is an unexpected change in my mental health coverage, and thus a strong chance that I may not be able to see my current psychiatrist anymore. My options for a new provider are very limited, and quite frankly, ones that I am not comfortable with. I should add that I was already struggling with the fact that my doctor is going on maternity leave at the end of the summer. I have failed most medications and underwent genetic testing as a result. We were in the process of formulating a plan surrounding medication and her upcoming leave when I got slammed with the frustrating news regarding insurance. My doctor is aware of the situation and is currently processing viable options, but I am preparing myself for forced discharge from the clinic and having to stop my medication. I told my therapist, and her main concern surrounds the loss of the relationship with my psychiatrist. My doctor is the first one to see me as a person, actually listen instead of automatically pushing medication, and correctly diagnose PTSD. I know how hard it is to find psychiatrists like her, so ending our relationship is, and will be, extremely difficult. I even put off a major surgery because of her maternity leave and my not being comfortable in the hospital while she is gone, especially since my trauma stems from medical procedures and emotional abuse.

There is a possibility of paying a new provider privately because I have financial support from my parents, but building a new relationship is another story. I don't know if I have a question or if I'm just looking for compassion. I think I just needed to vent. Along with the loss of an important relationship, my concern/dilemma lies in where and how to proceed with therapy. I find EMDR extremely helpful in terms of getting in touch with emotions, but I'm not sure if I'm comfortable continuing without medication. On the other hand, if I lose EMDR, I lose my only access to difficult emotions right now. I also wonder how this will change my relationship with my actual therapist? Having a disability has allowed me to learn how to navigate issues with insurance companies, but I've hit a roadblock that may be impossible to overcome.

Also, do you have any thoughts on encouraging my younger self to speak? She has trouble finding words/expressing needs (feelings) and is unable to write or draw because of physical limitations. Any ideas for how to satisfy her need to be held? My parents are emotionally unavailable, and it's obviously not appropriate for the therapy room. Trying to find a balance between appropriate touch/physical contact and keeping healthy therapeutic boundaries. Thanks for listening!
 
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Hi @HollyBeans27, don't know if I have anything useful for you but here are my thoughts. I'm in Texas and registered with DARS, the department of assistive and rehabilitative services; they have psychiatrists and psychologists contracted with them. Don't know what state you are in, but maybe you could find the equivalent (if you haven't already). Hopefully you can find more options.

I also wondered if you have tried any play or art therapy? It is useful for children; seems like it could be useful for inner children as well. Hope you find the help you need. Take care.
 
It's nice to hear from you, @HollyBeans27 - I'm sorry things are rough.

If you can pay for non-insured sessions (through your parents support) can you do that in order to stay with your current doc?

Or, does your current one have any strong referrals for possible new doctors? I've always felt more comfortable seeing new practitioners that my current psych recommends specifically - doctors have relationships with other docs who align with the same principals of care, so if your current psych likes and respects someone else, chances are you will, too.
 
First, my apologies for not responding sooner. Thank you for the suggestions @Broken Dahlia and @joeylittle. Unfortunately, I have been down this road quite a few times because of my disability and have exhausted the options you mentioned. As you can imagine, I have been on the phone with both my insurance company and the clinic of my current doc almost constantly. Tomorrow's appointment is my last covered session with my psychiatrist, so we will see what happens. My focus has shifted from "how can I rectify the situation?" to developing a new crisis plan and working out the details of what that can and should look like. My psychiatrist was a key part of that plan because my disability makes normal steps like hospitalizations, etc. near impossible. Reality is that the situation I described in my original post is not negotiable in that I am prepared to be without a doctor and off medication for the foreseeable future. Not ideal by any means, but reality. I also know myself in that the unfortunate reality will likely insinuate an emotional crisis. What I am not prepared for is how to handle it, who can be a part of my support network, etc. Now that is my biggest concern, and my inner child is anything but happy and stable. I have been able to intersect and handle crises appropriately in the past, but this one will be unlike any other I've experienced. I am entering uncharted territory. I will try to update soon with the outcome, good or bad. Thanks again, I hope you're doing well!
 
Keep us posted. It sounds like a tough situation. I'm sorry your current psych can't accept direct payment (sounds like).

I'll be thinking of you.
 
Hi everyone,

I have a long awaited, yet confusing update. I saw my neurologist a few weeks ago, and explained the medication issue to him. He agreed to prescribe them while my psychiatrist is on maternity leave, so I was very excited and thought I had everything worked out. Told my psychiatrist the good news at my appointment, and she was very pleased to say the least because she is having complications and may be going out sooner than expected. Too good to be true right? I don't have everything figured out because I am regularly on an antibiotic that interacts with my psych med. I've managed to work around it with IV antibiotics to control frequent infections caused by secondary medical conditions to my disability, but I can no longer avoid using the medicine causing the interaction. This means, we need to redefine a plan and Monday may be my last appointment with the psychiatrist for at least six months. Can you say freaking out? Not to mention another unsettling situation created by my actual therapist and going to grad school to be one… That's a problem for another post. Just thought I'd keep everyone posted, even though I feel like I'm back at square one.
 
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